tbuckley/cabot-search huggingface dataset:
Abstract 12996: Outcomes of Cardiac Resynchronization Therapy in Transthyretin Wild-Type Cardiac Amyloidosis
Authors: Ojasav Sehrawat, Hannah P Alcantara, Nicholas Y Tan, Anwar A Chahal, Anthony H Kashou, Omar S Latif, Maren Maanja, Konstantinos Siontis, Wayne L Miller, Peter A Noseworthy, Grace Lin
Journal: Circulation (2022)

Introduction: Cardiac resynchronization therapy (CRT) has known benefit for heart failure (HF) with reduced left ventricular ejection fraction (LVEF) and dyssynchrony. However, very little is known about its benefit in infiltrative cardiomyopathies such as cardiac amyloidosis (CA) due to relative rarity of these conditions. Methods: This retrospective case series (2003-2021) comprised patients with HF due to transthyretin wild-type CA with (case) or without (control) CRT implant. Only controls with an indication for CRT or LVEF &lt;40% were included. To further match disease severity, cases were 1:1 matched (propensity score tolerance 0.04) to controls for age, NYHA class, and CA stage (UK Staging). Primary outcome was MACE (major adverse cardiac events) which included stroke, myocardial infarction, HF hospitalization and cardiac mortality during a 3-year follow-up. Loss to follow-up was censored as per last visit date. LVEF and NYHA were noted closest to 1-year follow-up. Survival analysis for MACE was performed with Kaplan-Meier (KM) and multivariable cox regression models. Results: Study Cohort (n=160) had a mean age of 75.5 (SD 7.8) years and 97.5% were males. A majority had NYHA class 2 or 3 (92.3%) and CA stage 2 (42.2.%). Notably, median LVEF at baseline was lower in controls (33.5 vs 36.5; P = .001) and 77.5% of controls had an indication for CRT device. A total of 79 MACE events occurred, most frequent being HF hospitalization (n=45). KM curves were comparable for MACE events in the two groups (log-rank test; P = .059). Even after adjusting, as in table, CRT device was not associated with MACE events (adjusted HR 0.66; 95% CI 0.40-1.09; P = .106). Lastly, change in LVEF ( P = .84) and NYHA ( P = .86) at follow-up was similar in cases vs controls. Conclusions: The findings of this largest yet observational study to examine this question suggest that CRT in patients with transthyretin wild-type CA does not favorably impact outcomes for MACE events, improve LVEF or NYHA functional class.
Abstract 13541: A Digital Health Ecosystem for Coronary Artery Bypass Graft and Percutaneous Coronary Angiography Facilitates Recovery for Patients in Their Homes
Authors: J A Taylor, Jyotsna Rao, Richard Singerman, Prem Sharma, Christine Hsieh
Journal: Circulation (2022)

Introduction: The transition from hospital to home disrupts the continuum of patient care, adversely impacting readmissions and patient engagement. Our study objective is to develop and assess a Digital Health Ecosystem (DHE) intervention to mitigate CABG and PTCA readmissions and improve patient satisfaction with minimal clinician burden. Methods We developed and assessed a DHE combining evidence-based personalized content; web-based clinician dashboards; patient caregiver mobile apps; and nurse care plans and escalation protocols (figure). A tertiary-care hospital in Bangalore, India deployed the DHE to address post-discharge challenges of CABG and PTCA. India is attractive for testing digital health due to its large population, large mobile phone penetration, large out of pocket healthcare costs and positive telehealth attitudes. In an IRB-approved retrospective study, Jan-Dec 2019, we assessed patient outcomes and satisfaction for 799 patients (CABG=325; PTCA=474). We used an all-comers real-world approach without exclusions to assess feasibility. Results Escalations of care (n=7665), were greater in CABG (n=4772; 15 per patient) compared with PTCA (n=2893; 6 per patient). The figure shows 101 higher level escalations from 82 patients (48 CABG, 34 PTCA) with 41 resolved via virtual care and 60 resulting in 35 ED visits and 17 hospitalizations. Net Promoter Score (NPS) indicated patients were loyal and likely to recommend the DHE. The hospital NPS increased by 60%, from hospital reported baseline of 47 to 75. Conclusions Only 10.3% of patients after discharge had serious complaints. There were relatively few ED visits (4.4% of patients) and even fewer readmissions (1.9%). This contrasts with Indian studies showing 10-20% readmission after CABG. We demonstrated a DHE that provides improved post-discharge patient care and satisfaction and can be implemented alongside traditional healthcare. Moreover, this DHE may significantly reduce readmissions.
Abstract 13832: Association of Intraoperative Red Blood Cell Transfusions With Venous Thromboembolism After Cardiac Surgery
Authors: Jacob Raphael, Xiaoke Feng, Matthew Shotwell, Michael Mazzeffi, Bruce Bollen, Ashish Shah, Miklos D Kertai
Journal: Circulation (2022)

Introduction: Cardiac surgeries have among the highest overall rate of packed red blood cell (PRBC) transfusion among all other surgeries. Recently published data suggests that intraoperative PRBC transfusion is associated with increased risk for postoperative venous thromboembolism (VTE) after non-cardiac surgery. However it is unknown whether similar association also exists after cardiac surgery. Hypothesis: Intraoperative PRBC transfusion would be associated with increased risk of postoperative VTE after coronary artery bypass (CABG) surgery. Methods: We analyzed all the patients undergoing CABG surgery between January 1, 2015 and December 31, 2019 in the Society of Thoracic Surgeons (STS) adult cardiac surgery database. Using propensity-score-weighted regression analysis, we analyzed the effect of intraoperative PRBC transfusion on hospital-acquired venous thromboembolic complications as well as on pulmonary venous thromboembolism, deep venous thrombosis, operative mortality, readmission within 30 days, and postoperative length of stay. Results: The overall rate of intraoperative PRBC transfusion was 17.8% (n=133,484). PRBC transfusion was associated with increased odds for venous thromboembolic complications (odds ratios, OR [95% CI]: 1.27 [1.22-1.32], 1.21 [1.16-1.26], 1.93 [1.85-2.00], and 1.82 [1.75-1.89]) in patients receiving 1, 2, 3 or 4 or more units, respectively. Intraoperative transfusion was also associated with increased odds for deep venous thrombosis (OR [95% CI]: 1.39 [1.33-1.46], 1.38 [1.32-1.44], 2.18 [2.09-2.28], and 1.82 [1.74-1.91]), operative mortality (OR [95% CI]: 1.11 [1.08-1.14], 1.16 [1.13-1.19], 1.29 [1.26-1.32], and 1.47 [1.43-1.50]), readmission within 30 days (OR [95% CI]: 1.05 [1.04-1.06], 1.16 [1.13-1.19], 1.29 [1.26-1.32], and 1.47 [1.43-1.50]), and a prolonged postoperative length of stay (mean difference in days, 0.23 [0.19-0.27], 0.34 [0.30-0.39], 0.69 [0.64-0.74], and 0.77 [0.72-0.82]. Conclusions: Intraoperative PRBC transfusion was associated with venous thromboembolic complications and adverse outcomes after coronary artery bypass grafting surgery.
Abstract 13139: Explainable Machine Learning Model for Prediction of Cardiovascular Disease With Routinely Collected Clinical Data Combined With Publicly Available Data on Environmental Risk Factors
Authors: Kyuwoong Kim, Sanghyun Oh, Yoo S. Hong, Jihwan Lee
Journal: Circulation (2022)

Introduction: Little is known about the performance benefit of combining these data with publicly available environmental risk factors for CVD prediction models. Hypothesis: We aimed to test whether routinely collected clinical data (age, sex, systolic blood pressure, total cholesterol, cigarette smoking) in combination with data on environmental risk factors could improve the performance of CVD prediction using an explainable machine learning (ML) technique. Methods: We identified individuals without previous history of CVD from the National Health Insurance Service, 2002-2015 in the Republic of Korea, linked to publicly available data on annual average of fine particulate matter (PM 10 ) exposure and urban green space coverage according to the administrative code for residence in each individual. Random forest (RF) model and SHapley Additive exPlanations (SHAP) value were used for prediction for newly diagnosed CVD and explanation for contribution of each component to the model output, respectively. Performance of the prediction models were evaluated using area under the curve (AUC). Results: Among 151,936 individuals included, there were 2,837 subsequent CVD events. The AUCs for the RF model with the clinical data only and the model with environmental risk factors (high annual average PM 10 and low UGS coverage) in addition to the clinical data were 0.731 and 0.733, respectively. The SHAP values showed that adding these environmental risk factors did not have significant impact on the model output (SHAP summary plot). However, the clinical data comprised of traditional CVD risk factors had notable contribution to the performance of prediction model. Conclusions: This study showed that adding publicly available data on environmental risk factors to the routinely collected clinical data had only marginal improvement in the prediction of CVD outcomes.
Abstract 13084: Clinical Outcomes and Factors for Adverse Events in Patients With Severe Coronary Calcification Assessed by Optical Coherence Tomography
Authors: Takako Nagata, Yoshiyasu Minami, Aritomo Katsura, Kiyoshi Asakura, Masahiro Katamine, Yusuke Muramatsu, Kazuhiro Fujiyoshi, Daisuke Kinoshita, Junya Ako
Journal: Circulation (2022)

Introduction: Severe coronary calcification is a known factor for worse clinical and angiographic outcomes after percutaneous coronary intervention (PCI). However, the association between lesion characteristics and post-stent findings and worse clinical outcomes in patients with severely calcified lesions remains to be elucidated. Hypothesis: Among patients with severely calcified lesions, pre and post stent findings assessed by optical coherence tomography (OCT) are associated with future adverse events. Methods: A total of 241 consecutive patients with severely calcified lesions, who underwent OCT imaging of the culprit lesion were included. Severely calcified lesion was defined as a lesion with a maximum calcium angle &gt;180°, maximum thickness &gt;0.5 mm and calcium length &gt;5 mm, which were assessed by OCT. The device-oriented clinical endpoint (DoCE) was defined as a composite of cardiac death, target vessel-related myocardial infarction, ischemia-driven target lesion revascularization, and stent thrombosis. Results: The presence of eruptive calcified nodule (eCN) (41% vs. 18%, p =0.003) in the culprit lesion and medial dissection with calcified flaps (59% vs. 26%, p &lt;0.001) after stenting was significantly higher in patients with DoCE than in those without. Among the four groups classified by the presence of eCN and medial dissection with calcified flap, incidence of DoCE was the highest in lesions with both eCN and medial dissection with calcified flap ( p &lt;0.001) (Figure). Conclusions: An increased incidence of DoCE was demonstrated in lesions with the combined presence of eCN and medial dissection with calcified flap. The present results may explain the importance of the careful assessment of severely calcified lesions using OCT for the risk stratification of future adverse events.
Abstract 13941: FTO Demethylase Mediates Altered N <sup>6</sup> -methyladenosine (m <sup>6</sup> A)-RNA Modification in Tyrosine Kinase Inhibitor-Induced Cardiotoxicity
Authors: Yan Ma, Dong Han, Tian Hu Wang, Shasha Sun, Yang Zhang, Feng Cao
Journal: Circulation (2022)

Background: N 6 -methyladenosine (m 6 A) methylation is dynamically regulated by writers and erasers, and ultimately affects RNA splicing, translation, and stability after by recognized readers, thereby affecting disease progression. Sunitinib (SUN) is a tyrosine kinase inhibitor (TKI) widely used to treat different types of solid and hematological tumors, but its cardiotoxicity limits its clinical application. FTO is an m 6 A demethylase has been shown to play an important role in various heart diseases. In this study, we deciphered the methylation modification of m 6 A mRNA in human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) post sunitinib treatment and assessed whether FTO regulated pyroptosis-related m 6 A methylated transcripts in SUN-treated hiPSC-CMs. Methods and Results: The global m 6 A RNA-methylation level was increased in SUN-treated hiPSC-CMs and was parallel with a positively correlated cellular damage level (LDH leakage). Through a genome-wide analysis of m 6 A mRNA methylation by MeRIP-Seq and RNA-seq, we identified a total of 2614 peaks with significant changes. qRT-PCR, immunofluorescence, and Western blot revealed that FTO was the most evidently changed m 6 A modifying enzymes in SUN-treated hiPSC-CMs (downregulated fold change being 0.43). Interestingly, the loss of FTO in hiPSC-CMs exposed to SUN was positively associated with cellular damage level and pyroptosis- associated NLRP3 and ASC transcripts levels. To further test if TKI-induced increase in m 6 A-RNA modification is mediated through FTO loss, hiPSC-CMs, overexpressed with ectopic FTO, showed significant restoration of m 6 A methylation level and normalization of pyroptosis-associated transcripts (NLRP3 and ASC) after exposure to SUN. To evaluate the effect of FTO on the methylation of RNA transcripts of NLRP3 and ASC, MeRIP assay demonstrated that FTO tightly controlled the methylation levels of NLRP3 and ASC transcripts, and demethylation of these transcripts by FTO accelerated their degradation rate. Conclusion: This study revealed that TKI-induced loss of FTO may mediate the decreased m 6 A-RNA methylation and TKI-induced cardiotoxicity pathogenesis by dysregulating the methylation and expression of pyroptotic transcripts NLRP3 and ASC.
Abstract 13009: Time to Implantable Cardioverter Defibrillator in Patients With Left Ventricular Ejection Fraction ≤ 35%
Authors: Jackeline P Vajta Gomez, Mehmet Elbey, Carolina I Borz-Baba, Joseph Gnanaraj
Journal: Circulation (2022)

Background: Implantable cardioverter-defibrillators (ICDs) are endorsed by the current American Heart Association (AHA) Guidelines as the cornerstone in the primary prevention of mortality in patients with reduced ejection fraction (EF) (≤35%). The timing for ICD therapy in non-ischemic cardiomyopathy (NICM) is not specified in the current guidelines. The objective of this study was to determine the timing for ICD insertion for patients with NICM versus ICM in the real-world population. Methods: Retrospective design study of patients with ICDs implantation from 2019 to 2022 at our community hospital. Data was obtained via the Device Implant Registry. All eligible participants had confirmed diagnosis of ICM and NICM on chart review; while confirmed EF≤35% on echocardiography. Categorical predictors and clinical outcomes were analyzed using Pearson’s chi-square test or Fisher’s exact test. Quantitative predictors and clinical outcomes were analyzed using Student's t-test or the Wilcoxon rank sum test. Results: Our cohort included 62 patients undergoing ICD placement for primary prevention. There was no statistical significance between patients based on age, sex, race, and EF. Average time to ICD placement was 134 days for patients with ICM and 274 days for patients with NICM, a difference that favoured NICM; p =0.009 ( p &lt;0.05). In the majority of patients, 64.5%, ICD implantation was deferred for at least 90 days compared to 35.5% patients who had an ICD placed by 90 days; p =0.001 ( p &lt;0.05). The mortality in our study was 13% over a median of 2 years, with a predominance of ICM as compared to NICM, 75% versus 25%, respectably. Logistics regression demonstrated that timing to ICD implantation was not an independent variable of mortality. The mean overall survival was 274.4 days (SD +/- 50) in NICM compared to 134.3 days (SD +/- 21) in the ICM group, p =0.007 ( p &lt;0.05). Conclusions: In a real-world population, time to ICD implantation was statistically different in ICM compared to NICM. ICM remains a significant risk of all-cause mortality despite the progress made in both medical and procedural treatments. Further studies are necessary to determine the appropriate time to ICD implantation in patients with NICM and reduced EF.
Abstract 14099: Prevalence of Left Ventricular Systolic Dysfunction Defined by Standard and Advanced Echocardiographic Measurements in Patients With Systemic Lupus Erythematosus: A Systemic Review and Meta-Analysis
Authors: Tea Gegenava, Maka Gegenava
Journal: Circulation (2022)

Introduction: Speckle tracking echocardiography (STE) can be an useful tool for detecting early and subtle myocardial changes in patients with systemic lupus erythematosus (SLE) Hypothesis: The present study aimed to perform systemic review and meta-analysis of the studies based on the assessment of the left ventricular (LV) systolic function with LV ejection fraction (LVEF) and LV global longitudinal strain (LV GLS). Methods: Data were analysed according to an established protocol of the Cochrane Collaboration steps and meta-analysis Results: A total of 850 papers were collected, of those 10 papers including 174 442 SLE patients and 45 608 723 controls with heart failure, also 20 papers including 1121 SLE patients and 1010 controls with measured LVEF and 9 papers including 462 patients and 356 controls with measured LV GLS were selected. Studies have shown, that patients with SLE were characterized with higher prevalence of heart failure as compared to controls (Fig1). Patients with SLE exhibited lower levels of LVEF as compared to controls too (Fig.1), some included studies have shown that the difference in terms of LVEF between groups is not always significant. LV GLS was more deteriorated in SLE patients as compared to controls (Fig.2a, 2b), moreover some studies showed significant association between deteriorated LV GLS and cardiovascular events. Conclusions: Patients with SLE are characterized with high prevalence of heart failure. LV systolic function as measured by LVEF and LV GLS is significantly more affected in SLE patients. Data suggest that LV GLS may improve risk-stratification in patients with SLE.
Abstract 14347: Rapid Calculation of Cardiology Risk Scores by Natural Language Processing of Unstructured Medical Record
Authors: Andy Huang, George C Liu, Paul C Lee
Journal: Circulation (2022)

Introduction: Risk score calculators such as ASCVD (for coronary artery disease), CHA2DS2-VASc (for atrial fibrillation), and H2FPEF (for diastolic heart failure) optimize outpatient cardiology care, but may not be routinely performed because calculation is time consuming. Natural Language Processing (NLP) methods can rapidly capture clinical data from unstructured medical records. Our aim was to create an algorithm that can rapidly calculate these scores using NLP methods. Methods: In the algorithm we created (named MYTH), demographic, history and physical, ICD10 diagnostic codes, laboratory, EKG, echocardiography data were captured by analysis of textual syntax, domain-specific knowledge graph, and regular expressions. The data captured are then fed into various risk score calculators. We compared the speed of the algorithm with manual calculation using a commonly used online calculator. Twenty outpatient cardiology unstructured medical records were used for each of the three risk scores. Results: NLP is faster than manual calculation. See attached table. Conclusions: NLP-based algorithm increases the speed of risk score calculation. The improvement is especially dramatic in complex risk scores, such as diastolic heart failure risk scores. NLP method can optimize cardiology care in time-constrained settings.
Abstract 13445: The Prognostic Value of Pulmonary Hypertension and Atrial Fibrillation in Rheumatic Mitral Stenosis
Authors: Jah Yeon Y Choi, Jieun Lee, You-Jung Choi, Byoung Geol Choi, Soohyung Park, Dong Oh Kang, Eun Jin Park, Ji Bak Kim, Seung-young Roh, Cheol Ung Choi, Jin w Kim, Eung Ju KIM, Seung-Woon Rha, Chang Gyu Park, Hwan Seok Yong, Man-Jong Baek, Jin O Na
Journal: Circulation (2022)

Introduction and Hypothesis: Rheumatic mitral stenosis (MS) is decreasing in developed countries; however, there has been a substantial number of patients with rheumatic MS in developing countries. Although the current international guideline of valvular heart disease defined the severe MS as MVA below 1.5 cm 2 and the new onset of atrial fibrillation (Afib) and pulmonary hypertension is one of the indications of MV intervention in asymptomatic severe rheumatic MS, there have been scarce supporting data. Therefore, we sought to investigate the prognostic value of Afib and pulmonary hypertension in severe rheumatic MS. Methods: We retrospectively collected data on rheumatic MS in a single center from 2006 to 2022. The clinical, echocardiographic characteristics and clinical outcomes were investigated. The incidence of major cardiovascular adverse events (MACE) including all-cause mortality, hospitalization for heart failure, and the thromboembolic event was investigated following 10 years. Results: A total of 792 patients were collected. The mean age of the population was 63 years old, the number of females was 71.8%, and the incidence of severe MS (MVA≤1.5 cm 2 ) was 37.4%. In patients with severe stenosis, there was no significant difference in MACE in Afib and non-Afib patients during the 10 years follow-up (Figure A). However, the presence of pulmonary hypertension, esp. pulmonary arterial systolic pressure above 50mmHg, demonstrated significantly worse clinical outcomes (Figure B). In multivariable Cox analysis, pulmonary hypertension (PASP≥50mmHg) was a significant prognostic factor of MACE after adjusting other covariables (HR 1.897, 95% CI: 1.352-2.663, p-value &lt;0.001). Conclusions: In severe rheumatic MS, the presence of pulmonary hypertension, not Afib, was a significant prognostic factor for clinical outcome. Further study with a larger population would be needed for more precise risk stratification and indication for MV intervention.
Abstract 14031: Sacubitril-Valsartan Effects on Atherosclerotic Outcomes: A Meta-Analysis of Randomized Trials
Authors: LIS VICTORIA RAVANI CARVALHO, Pedro Abi-Kair Borges Calomeni, Mateus de Miranda Gauza, Jussara Pereira, Rhanderson Cardoso
Journal: Circulation (2022)

Introduction: Sacubitril-Valsartan is an angiotensin receptor neprilysin inhibitor (ARNI) associated with a decreased risk of death and of hospitalization for heart failure. However, its effects on atherosclerotic disease outcomes are not definitively known. Methods: We performed a systematic review and meta-analysis comparing the effects of ARNI with angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) on acute coronary syndrome (ACS), myocardial infarction (MI), stroke, angina pectoris and peripheral artery disease (PAD). PubMed, Scopus and Cochrane Central were searched for randomized studies until June 2022. Results: Thirteen randomized controlled trials, with 20,981 patients were included; 10,483 (50%) patients received ARNI and 10,498 were treated with ACEI or ARB (50%). The incidence of MI (OR 0.96; 95% CI 0.79-1.16; p=0.62; Fig. 1A), ACS (OR 0.98; 95% CI 0.61-1.59; p=0.97; Fig. 1B), angina pectoris (OR 0.95; 95% CI 0.78-1.15; p=0.58) and stroke (OR 1.00; 95% CI 0.85-1.17; p=0.96) were not statistically different between groups. However, ARNI was associated with higher incidence of PAD (OR 1.60; 95% CI 1.03-2.47; p=0.04; Fig. 2). Conclusions: There was no significant difference between ARNI and ACEI or ARB in terms of ACS, MI, angina pectoris, or stroke, although there was a slightly higher incidence of PAD in patients treated with ARNI.